Coping with Cancer through Mindfulness

As complementary to mainstream medical and surgical treatment of patients with malignancies, meditative practices that focus on present-moment awareness can harness the mind’s holistic healing capability

By Buenaventura C. Ramos, Jr., MD, FPCP, FPSMO

What if today, you were diagnosed with cancer, what thoughts would come to your mind?

How would you feel?
How would you face the difficulties of choosing between treatments?
How would you cope with the trauma of facing and undergoing treatment?
How would you live with the possibility of recurrence, or face the diagnosis of recurrence?
How would you live with the progression of cancer?
How would you respond to the disclosure of terminal disease?

Life after a cancer diagnosis is filled with questions and challenging situations in every phase of the entire cancer experience. These can produce a lot of stress, which, in turn, can affect the quality of one’s life.

Cancer patients may have to face some, if not all, of these challenges at one point or another; these, plus the other problems of living that may or may not be linked to cancer.

Yet cancer is not always experienced as the greatest problem facing a person with cancer. Someone may be carrying a greater pain than the cancer, such as a death of a spouse, a separation or end of a relationship, a childhood trauma, a problematic child, loss of a job, or some other issue that takes more time and energy to deal with than what might appear from the outside to be the central life issue – cancer.

The fact that other problems in living may be more important than having cancer is of great importance to patients and those who care about them considering ways of healing. The first implication for any health professional, family member or friend who wants to help a person with cancer, or indeed for the cancer patient himself, is that the most effective help one can provide may be addressing a problem that has little, if anything, to do with cancer.

Addressing stress

Focusing attention on the problems of living can reduce the stress on the cancer patient, giving him more energy to cope with his cancer. Since stress may actually be a factor in the development and progress of some cancers, addressing the problems contributing to stress may have an effect on the course of the disease.

The application of current treatment techniques (surgery, radiation therapy, chemotherapy, and biologic therapy) results in the cure of nearly two of three patients diagnosed with cancer. Nevertheless, patients experience the diagnosis of cancer as one of the most traumatic and revolutionary events that has ever happened to them.

Independent of prognosis, the diagnosis brings with it a change in a person’s selfimage and in his or her role in the home and workplace.

One consequence of the disease is that the patient feels betrayed by his or her body. The cancer patient feels that he or she, and not just a body part, is diseased.

The experience of cancer is defined by a process of interconnection among the specific stages of a cancer experience, from receiving a diagnosis, deciding on treatment, completing a treatment, recovering functional capacity, adapting to the so-called “new normal”, and then living with an ever-present vigilance for signs of its return or durable remission.

The psychosocial needs of patients vary with their situation. Patients undergoing treatment experience fear, anxiety and depression. Self-image is often seriously compromised by deforming surgery and loss of hair. Women who receive cosmetic advice that enables them to look better also feel better. Loss of control over how one spends time can contribute to the sense of vulnerability. Juggling the demands of work and family with the demands of treatment may create enormous stresses.

Cancer survivors have other sets of difficulties. Patients may have fears associated with the termination of a treatment they associate with their continued survival. Adjustments are required to physical losses and handicaps, real and perceived. Patients may be preoccupied with minor physical problems. They perceive a decline in their job mobility and view themselves as less desirable workers. Patients may experience difficulty reentering their normal past life. They may feel guilty for having survived and may carry a sense of vulnerability to colds and other illnesses. Perhaps the most pervasive and threatening concern is the ever-present fear of relapse, termed, the Damocles syndrome.

Patients in whom therapy has been unsuccessful have other problems related to the end of life.

So, in all phases of the cancer experience, marked by the event in relation to diagnosis and treatment, or in relation to the stage of the disease, whether early, recurrent or advanced, patients face different challenges.

Mindfulness-based cancer recovery

How can we respond to these challenges? Can we harness the power residing in the mind to develop a healing perspective and apply it in those very moments when we become lost in thoughts, worries, or fears about a limited future?

Research shows that if we mentally prepare ourselves to handle cancer treatment by getting stress and anxiety under control, we can improve our quality of life and become an active participant in our own recovery.

The mindfulness-based cancer recovery (MBCR) program is characterized by the clinical application of meditative practices that are designed to help patients develop a particular form of awareness, known as mindfulness.

Mindfulness is often defined as present moment nonjudgmental awareness. This is contrasted to typical experience that may involve ruminating over events of the past, planning or worrying about the future, or analyzing and judging current experience. These could result to the unpleasant feelings of guilt from past lifestyle, fear about the uncertainty of the future or imagined negative outcome, and uncomfortable present moment experience because of resistance to it, rather than accepting it.

Mindfulness practice can take the form of formal meditation or informal practices, such as simply remembering to be present as one undertakes day-to-day tasks. The practice of mindfulness through formal meditation and informal practice ideally leads to a more mindful way of living. This intense sense of presence leads to a cascade of beneficial effects that flow through all the aspects of daily life.

Being in this present moment, letting go, practicing non-attachment and acceptance are so helpful in dealing with the uncertainty and fear that commonly associate with the cancer experience.

With this eight-week program, the patients learn to calm feelings of fear, uncertainty, and lack of control. They mindfully manage difficult symptoms and treatment side effects. They boost their immune function through meditation and healing yoga, which are the main techniques used by this program. Then they eventually discover their own capacity for healing and thriving after adversity.

The origins of mindfulness can be traced to the wisdom traditions of Asia, where it has been taught for over 2,500 years. The program is a part of a recent trend that has seen these practices for use in Western medicine. This turns out to be a productive union, since the standard forms of cancer care such as medication, surgery, chemotherapy and radiation therapy are rarely sufficient to meet patients’ ongoing needs.

Presently, this program falls under the realm of Complementary Therapies. Conventional medicine and the medical education, in general, focused so much on the body that, somehow, the other aspects of a human being – the mind and the spirit – were left out in the management. And yet, a whole person is composed of these three aspects, mind, body and spirit, thus for medicine to be holistic, must involve management of all these.

Preliminary studies documented the efficacy of the program, for improving stress symptoms, anxiety, depression, mood and symptoms, such as fatigue and sleep problems. Later studies showed effects of the program across a wide range of biomarkers, such as salivary cortisol, which is a biological marker or stress reaction, certain substances secreted by immune system cells called cytokines and blood pressure.

Current randomized controlled trials pit the MBCR program against other active and empirically-supported treatments for a range of symptoms, from general distress to clinical insomnia. Mindfulness-based interventions hold a great deal of promise for helping people with cancer cope across a broad range of symptoms and issues. The effectiveness of MBCR stems from its focus on the whole person and not just the cancer diagnosis.

But why is being mindful and doing the exercises and techniques that can improve one’s focus on the present moment experience be specifically helpful for cancer patients?

Cancer still has that stigma linked with premature death – the thought that he or she would die way before everyone else – although this may not be true in most cases. This seems to be the root cause of the challenges of the entire cancer experience. Yet, somehow, this may also have one beneficial effect. Since cancer makes one consciously face his or her own mortality, it is that recognition that life is temporary that allows us to live more fully in the moment.

This program reminds us on how to do this, and provides us with the tools that we can use to train our minds in such a way that we become more deeply involved with life as it unfolds, moment by moment.

“Being in this present moment, letting go, practicing non-attachment and acceptance are so helpful in dealing with the uncertainty and fear that are commonly associated with the cancer experience”